Pharmacotherapy for hospital-acquired pneumonia

Introduction: Hospital-acquired pneumonia is the most common life-threatening hospital-acquired infection, and the majority of cases are associated with mechanical ventilation. Once pneumonia develops, the appropriateness of the initial antibiotic regimen is a vital determinant of outcome. The slow rate of development of newer antimicrobials has led to the rediscovery of the 'old' and 'forgotten' antibiotic 'Colistin', and it is increasingly being used as salvage therapy in patients with multidrug-resistant gram-negative bacteria infections. Areas covered: This article covers medical literature published in any language since 1990 until November 2011, on 'hospital pneumonia', identified using PubMed, MEDLINE and clinicaltrial.gov. The search terms used were 'ventilator associated pneumonia', 'management' and 'new antibiotics'. Expert opinion: Many controversies still remain in the management of hospital-acquired pneumonia. A continuous evaluation of the antimicrobial therapeutic options, along with their pharmacodynamic and pharmacokinetic profiles, is mandatory to optimize therapy and reduce hospital pneumonia-related mortality.